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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320218
Report Date: 10/04/2023
Date Signed: 10/04/2023 03:41:42 PM

Document Has Been Signed on 10/04/2023 03:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:GRANDVIEW GUEST HOMEFACILITY NUMBER:
198320218
ADMINISTRATOR:SANTOS, JENNICE-RAE RUTAFACILITY TYPE:
740
ADDRESS:2444 235TH STTELEPHONE:
(310) 782-5045
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: 6CENSUS: 5DATE:
10/04/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Coty Cabral, PresidentTIME COMPLETED:
03:50 PM
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On 10/04/2023 at 1:45 PM, Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Continuation Inspection and met with Coty Cabral, President. Five (5) residents and three (3) staff were present during this inspection.

Administrator, LPM, and LPA tested the smoke detectors and carbon monoxide, interviewed two staff and two residents, reviewed five staff records, infection control, emergency disaster plan, and plan of operation.

Common areas were clean and clear of hazards, doorways were free of obstructions.

The hot water temperature properly measured at 108.3F. One fire extinguisher, last serviced February 10, 2023 was observed in the kitchen area.

An exit interview was conducted and technical assistance was reviewed. A copy of this report was discussed and left with Coty Cabral, President.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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